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Samha R, Raya M, Mansour M, Mansour A, Mohsen MA, Alromhain B. Primary pituitary abscess with atypical imaging features: A rare case report. Int J Surg Case Rep 2024; 119:109753. [PMID: 38761689 PMCID: PMC11127560 DOI: 10.1016/j.ijscr.2024.109753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE A pituitary abscess (PA) is an extremely rare disease. It is characterized by the presence of an infected purulent collection within the Sella turcica. PAs are categorized in two categories: primary, when the pituitary is normal before the infection, or secondary, when there is a pre-existing sellar pathology (e.g., pituitary adenoma, Rathke's cleft cysts, or craniopharyngioma), meningitis, paranasal sinusitis, or head surgery, which may be indicative of the source of infection. CASE PRESENTATION We presented a case of a 52-year-old male with visual disturbances. Both a computerized tomography scan and magnetic resonance imaging revealed a sellar mass lesion, initially suspected to be a pituitary tumor. During transsphenoidal surgery for excision of the pituitary mass, an amount of pus was drained, indicating a pituitary abscess, which was confirmed by positive Staphylococcus aureus colonies in the culture. After surgery, the patient received antibiotic treatment for 12 weeks. After two years of follow-up, the patient remained free of complications and did not require hormone replacement therapy. CLINICAL DISCUSSION In previous research, there were a total of 488 patients, of those, 318 were primary pituitary abscess. Preoperative diagnosis is still difficult due to a combination of nonspecific symptoms and imaging findings. Endonasal trans-sphenoidal pus evacuation, culture, and individualized antibiotic therapy are available treatment options. CONCLUSION Pituitary abscess is a rare illness, but it should always be considered when evaluating a patient with a fast visual decline. Following the diagnosis, surgery and antibiotics should be started immediately. Proper therapy usually yields a positive effect.
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Affiliation(s)
- Raghad Samha
- Faculty of Medicine, AlBaath University, Homs, Syrian Arab Republic.
| | - Maria Raya
- Faculty of Medicine, University of Kalamoon, Damascus, Syria
| | - Marah Mansour
- Faculty of Medicine, Tartous University, Tartous, Syrian Arab Republic
| | - Amal Mansour
- Faculty of Medicine, Tishreen University, Lattakia, Syria
| | - Mohammad Ayham Mohsen
- Faculty of Medicine, Department of Neurosurgery, Damascus University Hospital, Damascus, Syrian Arab Republic
| | - Basel Alromhain
- Faculty of Medicine, Department of Neurosurgery, Al Assad University Hospital, Damascus, Syrian Arab Republic
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Xue Q, Shi X, Fu X, Yin Y, Zhou H, Liu S, Sun Q, Meng J, Bian L, Tan H, He H. Pituitary abscess: a descriptive analysis of a series of 19 patients-a multi-center experience. Eur J Med Res 2024; 29:262. [PMID: 38698484 PMCID: PMC11067254 DOI: 10.1186/s40001-024-01749-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 02/26/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES Pituitary abscess (PA) accounts for only 0.3-0.5% of sellar masses, and the lack of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy. In clinical practice, PA is often mistaken for cystic pituitary adenoma, craniopharyngioma, and Rathke's cyst. Thus, this study aims to investigate challenges in diagnosing PA and evaluate the importance of combining intraoperative surgery with postoperative antibiotic treatment. METHODS We conducted a retrospective analysis of 19 patients diagnosed with PA through histopathology. All patients underwent transsphenoidal surgery (TSS) for pituitary adenomas after undergoing comprehensive preoperative evaluations, including routine tests, endocrine assay, and imaging examination. Furthermore, we compared different treatments for pituitary abscess (PA) to determine the most effective approach for achieving a favorable prognosis. RESULTS The most prevalent symptom of PA was headache, especially in the frontal-temporal and vertex regions, ranging from mild to moderate severity. Hypopituitarism-related symptoms were also frequently observed, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Twelve patients exhibited abnormalities in endocrinology examinations. Diagnosing PA correctly is challenging. In our study, none of the patients were correctly diagnosed with PA prior to surgery, and many sellar lesions were misdiagnosed. The favorable prognosis was largely attributed to surgical intervention and active postoperative antibiotic therapy. CONCLUSIONS Given the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics treatment are more indicative of the correct diagnosis than other tests. In terms of therapy, optimal surgical intervention and active postoperative antibiotic treatment contribute to resolving the challenges posed by PA.
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Affiliation(s)
- Qiang Xue
- Departments of Neurosurgery, The Third Affiliated Hospital, Naval Medical University, Shanghai, 200438, China
| | - Xiuhua Shi
- Department of Radiotherapy & Oncology, The No. 2 People's Hospital of Wuhu City, Wuhu, Anhui, China
| | - Xiaoling Fu
- Department of Medical Psychology, The Fourth Medical Center of PLA General Hospital, 51 Fu Cheng Road, Beijing, 100048, China
| | - Yating Yin
- Departments of Neurosurgery, The Third Affiliated Hospital, Naval Medical University, Shanghai, 200438, China
| | - Hui Zhou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Suiyi Liu
- Department of Medical Engineering, Third Affiliated Hospital of Navy Military Medical University, Shanghai, 200438, China
| | - Qingfang Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Rui Jin Er Road, Shanghai, 200025, China
| | - Jin Meng
- Institute of Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Liuguan Bian
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Rui Jin Er Road, Shanghai, 200025, China.
| | - Hong Tan
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Hua He
- Departments of Neurosurgery, The Third Affiliated Hospital, Naval Medical University, Shanghai, 200438, China.
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Wu J, Deng P, Qian J, Lu Y, Ding Z, Hu X, Gong Y, Tang X, Ma M. Endoscopic endonasal transsphenoidal surgery for unusual sellar lesions: eight cases and review of the literature. Front Neurol 2024; 15:1309691. [PMID: 38414554 PMCID: PMC10896968 DOI: 10.3389/fneur.2024.1309691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/26/2024] [Indexed: 02/29/2024] Open
Abstract
Background Preoperative imaging for some unusual lesions in the sellar region can pose challenges in establishing a definitive diagnosis, impacting treatment strategies. Methods This study is a retrospective analysis of eight cases involving unusual sellar region lesions, all treated with endoscopic endonasal transsphenoidal surgery (EETS). We present the clinical, endocrine, and radiological characteristics, along with the outcomes of these cases. Results Among the eight cases, the lesions were identified as follows: Solitary fibrous tumor (SFT) in one case, Lymphocytic hypophysitis (LYH) in one case, Cavernous sinus hemangiomas (CSH) in one case, Ossifying fibroma (OF) in two cases; Sphenoid sinus mucocele (SSM) in one case, Pituitary abscess (PA) in two cases. All patients underwent successful EETS, and their diagnoses were confirmed through pathological examination. Postoperatively, all patients had uneventful recoveries without occurrences of diabetes insipidus or visual impairment. Conclusion Our study retrospectively analyzed eight unusual lesions of the sellar region. Some lesions exhibit specific imaging characteristics and clinical details that can aid in preoperative diagnosis and inform treatment strategies for these unusual sellar diseases.
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Affiliation(s)
- Jiandong Wu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Peng Deng
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jinhong Qian
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yanli Lu
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhiliang Ding
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaolong Hu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yuhui Gong
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaoyu Tang
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Mian Ma
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
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Zhuang BB, Chen J, Zhang Q, Zhang GL, Shi SS. Diagnosis of pituitary abscess and treatment via transsphenoidal surgery: experience from 15 cases. Neurochirurgie 2023; 69:101478. [PMID: 37598621 DOI: 10.1016/j.neuchi.2023.101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Pituitary abscess is an often misdiagnosed, rare clinical disorder. To improve diagnostic accuracy and the efficacy of surgical and antibiotic therapy for patients with pituitary abscess, herein, we retrospectively reviewed 15 patients who presented with pituitary abscesses from 2005 to 2022. DESIGN Retrospective study. PATIENTS Fifteen patients underwent transsphenoidal surgery and received antibiotic treatment. MEASUREMENTS Complete details regarding medical history, clinical manifestations, laboratory examinations, imaging studies, and treatment strategies were obtained for all patients. RESULTS Most patients presented with hypopituitarism and headaches, while some presented with fever, visual disturbances, and diabetes insipidus (DI). Abscesses showed significant annular enhancement post gadolinium injection. In most patients, pituitary abscess can be cured via microscopic or endoscopic drainage of the abscess followed by antibiotic treatment. Complete cure of pituitary abscess was observed in nine patients, with six cases of prolonged hypopituitarism and only one case of recurrence. Long-term hormone replacement therapy was effective in the postoperative management of hypopituitarism. CONCLUSIONS The typical manifestations of pituitary abscess include hypopituitarism and headaches; the presence of an enhanced ring at the edge of the mass on contrast-enhanced magnetic resonance images (MRI) is highly suggestive of pituitary abscess. We recommend antibiotic treatment for 4-6 weeks postoperatively, based on the results of bacterial cultures or metagenomic next-generation sequencing (mNGS).
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Affiliation(s)
- Bing-Bo Zhuang
- Department of Neurosurgery, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Jing Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China.
| | - Qiang Zhang
- Department of Neurosurgery, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Guo-Liang Zhang
- Department of Neurosurgery, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Song-Sheng Shi
- Department of Neurosurgery, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
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Kawano T, Shinojima N, Hanatani S, Araki E, Mikami Y, Mukasa A. Atypical pituitary abscess lacking rim enhancement and diffusion restriction with an unusual organism, Moraxella catarrhalis: A case report and review of the literature. Surg Neurol Int 2021; 12:617. [PMID: 34992933 PMCID: PMC8720480 DOI: 10.25259/sni_835_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background:
Pituitary abscess (PA) can be fatal if diagnosed late. Rim enhancement is a typical radiological finding of PA on postgadolinium T1-weighted magnetic resonance imaging (MRI). Diffusion-weighted imaging is helpful in distinguishing PA from other sellar cystic lesions. Herein, we report the first atypical case of PA showing neither rim enhancement nor diffusion restriction with an unusual organism, Moraxella catarrhalis.
Case Description:
A 77-year-old woman presented with headache, polyuria, polydipsia, and fatigue for a month before presenting to a local hospital. MRI showed pituitary enlargement with contrast enhancement. She had neither fever nor visual deficits and was followed up with hormonal replacement. Six months later, she complained of visual impairment, and MRI showed further pituitary enlargement with a thickened stalk compressing the optic chiasma. Neither rim enhancement nor diffusion restriction was observed. Endoscopic endonasal transsphenoidal surgery was performed based on the radiological diagnosis of lymphocytic hypophysitis or pituitary tumors. A thick, creamy yellow pus was drained from the sellar lesion. Intraoperative rapid histopathological findings revealed polymorphonuclear leukocytes infiltrating the pituitary gland. PA was diagnosed, and irrigation and open drainage of the abscess was performed. Bacterial culture of the pus detected M. catarrhalis by mass spectrometer, confirming the diagnosis. She underwent appropriate antibiotic administration, and her visual deficits improved.
Conclusion:
We report the first atypical case of PA showing neither rim enhancement nor diffusion restriction with M. catarrhalis. Even if preoperative findings are not suggestive of PA, it should be considered as a differential diagnosis. Intraoperative rapid histopathological findings are useful for accurately diagnosing PA and initiating appropriate surgical treatment.
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Affiliation(s)
- Tatsuya Kawano
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Satoko Hanatani
- Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Eiichi Araki
- Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
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